Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice
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COMMENTARY
Open Access
Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice Susan Shenoi1*† , Kristen Hayward1†, Megan L. Curran2, Elizabeth Kessler3, Jay J. Mehta4, Meredith P. Riebschleger5 and Helen E. Foster6
Abstract Background: The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. Body: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. Conclusion: This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed. Keywords: Telemedicine, E-visits, Models of care, V-pGALS, Covid-19
Background The COVID-19 pandemic has forced rapid changes in the way that medical care is delivered worldwide. Virtual care models with remote clinics and video visits (e-visits or telemedicine) have become widespread practice overnight. The adoption of telemedicine in pediatric rheumatology has been limited historically [1] and the importance of physical examination cited as a barrier [2]. Furthermore, regulatory complexity, decreased reimbursement rates and technical limitations have hampered robust development of telemedicine. However, for many providers and families the * Correspondence: [email protected] † Susan Shenoi and Kristen Hayward joint first authors with equal contribution 1 Department of Pediatrics, Division of Rheumatology, Seattle Children’s Hospital and Research Center, University of WA, MA.7.110 4800 Sand Point Way NE, Seattle, WA 98105, USA Full list of author information is available at the end of the article
pandemic has resulted in a need for pragmatism often in the absence of formal training or sophisticated technical support. The unique need to balance social distancing with providing ongoing care to an often immunosuppressed patient population combined with relaxation of regulatory demands has enabled rapid expansion of video visits. The American College of Rheumatology position statement on telemedicine also reflects this rapidly evolving need (https://www.rheumatology.org/Portals/0/Files/Telemedicine-Position-Statement.pdf). This commentary describes practical creative approaches based on our experiences and discusses the potential for telemedicine to address unmet needs in the wider context of pediatric rheumatology.
Administrative and governance consid
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